HomeMy WebLinkAbout014-1057-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353266
Permit Holder's Name: y []Village [] Tlqwn of: State Plan ID No..
❑Cit
Junker Jamie Town of Forest # Z. I - - rams• lb*
CST BM Elev.- Insp. Description: B Elev.: BM arcel Tax No.:
too / 1(02.3(, joo , 3b ,' �d eg Q�, A n 014 - 1057 -40 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Zip Benchmark 4. 3(o larar
Dosing 11 Alt. BM O O2_
Bldg. Sewer G , YD
Holding St/ Ht Inlet c, $2
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air into e ROAD Dt Inlet �--
Septic >� eo I + ( �' S s'�� NA Dt Bottom
o 1 T
Dosing -� t I D NA Header / Man. �' Co 9.
e NA Dist. Pipe
ng Bot. System '� _ If 3 � 8.5 3
PUMP/ SIPHON INFORMATION Final Grad i4111t (2f
Manufacturer C- Demand St cover J
Model Number Ifo GPM q vU r
oz,
TDH Lift Friction q System.Z� TDH Ft asp a elfL�ri� b ®x
Forcemain Length Dia. H Dist. To Well -�-; �3 t^1 '> •�a jnS�.96� )02. - Y. '
SOIL ABSORPTION SYSTEM
ED ) TRENCH width C I Lengyh r �tTDIME No. Of Pits Inside Dia. Li uid Depth
EN 1 N 1
SYSTEM TO P/ L BLDG WELL LAKE/STREAM L IN& anu acturer:
SETBACK CHAMB
INFORMATION Type O / e Num be r:
System: >/b0 y- QO 7- All- OR UNIT
DISTRIBUTION SYSTEM 10 10 4-."
Header/Manifold �. Distribution Pipe(s) , u x Ho I Sizg x Hole Spacing Vent To Air Intake
r.
Length Dia. Length �QO Dia. 2 Spacing �6
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed/ Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ o
COMMENTS (Include code discrepancies, persons present, etc.) Inspection
4 1 1 1 : C.." Si //y /Q9 Inspection # : y /2b /oU
Location: 1930 Highway P, Glenwoo Ci WI A4 13 NE 1/4 SE 1/4 27 T31N R15W) - 27.31.15.429/ L , s J
1.) Alt BM Description= b&4& - L
2.) Bldg sewer length = CIS 0'
-amo over
3.) contour q r� }.��CS�``�!tr ceuc✓
Plan revision requirecrf ❑ Yes
Use other side for additional information. 144::H AA�
SBD -6710 (R.3197) Date Inspector's Signature Cert No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
Vi sconsin SANITARY PERMIT APPLICATION 201 Bo Washington Avenue
In accord with ILHR 83.05, Wis. Ad m. Code
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syste , C)rV less `. County ��`
than 8 112 x 11 inches in size. �. - '
• See reverse side for instructions for completing this appli Pion P ° r^ !I r^ State Sanitary Permit rfumber
Personal information you provide may be used for secondary purposes ( _ . , ❑ Chis;ck it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. �' c ti ft�Clt�
State<Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT AL __ F R .'c2 7 9 9 11
Property Owner Name - Location
;.. A 1 yG� '7 T 3/ r N, R/ 9 E (o W
Property Owner's Mailing Address mher - Block Number
S (3 / v P . I �.—
Ci y, St to Zip Code Phone Number Sub NISI n ime or CSM Number
t . TYPE F BUILDING: (check one) E] State Owned It Nearest Road
Public or 2 Family Dwelling - No. of bedrooms S Town o rP
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a 1 I S•
OS —40
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1-j2ja1ew 2. ❑ Replacement 3 ❑ Replacement of 4. ❑Reconnection of 5_ ❑ Repair of an
__System ________ System_____________ Tank Only______________ Existing System ________ Existing System
j B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 2 �JlAound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure S ri 42 ❑ Pit Privy
13 [1 Seepage Pit r K b 3 6�l1L 43 ❑ Vault Privy
14 [] System-In-Fill p �, o IN�R�Qr
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ftJ (Min. /inch) Elevation
i O O S l 'L ""' �� �- 'f Feet / . 2 -Feet
Capacit
VII. TANK in Ca allon Total # of Prefab. Site Fiber- Ex p er.
FO TION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic A p p
New Existin structed
Tanks Tanks
Sep nk or Holding Tank >e 1L S o ,® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber I X I 750 ® I ❑ I ❑ I ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber' ature: (No Stamp) MP /MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State Zip Code): _
ao 9' /'�L N LJ S�Oa
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
M Approved E] Owner Given Initial Surcharge Fee)
Adverse Det ermination 3 � • jL f3
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS '
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
in TDD #: (608) 264 -8777
�scons www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
December 03, 1999
CUST ID No.226900 ATTN: POWTS INSPECTOR
ZONING OFFICE
SHAUN R BIRD ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 12/03/2001 Identification Numbers
Transaction ID No. 279991
Site ID No. 184661
SITE: Please refer to both identification numbers,
Site ID: 184661 above, in all correspondence with the agency.
ST CROIX County, Town of FOREST; HWY 64
SW1 /4, SETA, S27, T3 IN, RI 5E
JAIME JUNKER HWY 64
FOR:
Description: MOUND SYSTEM FOR JAIME JUNKER
Object Type: POWT System Regulated Object ID No.: 638773
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 11/23/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
KEITH A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM
KWILKINSON @COMMERCE.STATE.WLUS WiSMART code: 7633
cc: JAIME JUNKER
ti
PLOT PLAN
PROJECT Jaime Junker ADDRESS 11550 Stillwater Blvd. N Lake Elmo Mn 55042
NE 1/4 SE 1 /4s 27 /T 31/ N/R 15 TOWN Forest COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/19/99 BEDROOM 4
CONVENTIONAL IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
)000( SEPTIC T GArP�1C SI ZE 1250 gallons LIFT TANK SIZE DOSE G
MOUND TANK SIZE 750
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 500 BED SIZE 8'X 63'
BENCHMARK V.R.P. Top of White Stake ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 102.4
1320' Property Line
Scale = 1 /4 11 = 10'
350'
12%
Slope Area 25'below
system is to remain
Alt. B.M. undisturbed
800°
B. M. B -2 B -1
❑ ❑
System is to be
installed along the
101.4 Contour Line
Li
B -3
Tank is to be properly
bedded and provided Huffcutt Combo Tank
with a lock down cover
with a approved
warning label
County Road P
Well is to meet all setbacks found in Comm 83
Pro 4
Y Bedroom
-'� House
i
Ll i_
o w
SR��
Designer Rio
Date / 5 0 9 9
4" Observation Pipe perforated Non -Woven Filter Fabric
Below Filter Fabric
' / ODisfribulipn pip
ASTH C - 33 Send r .
" Topsoti a
suss :.r„rs r
r is a a
LZ
/ % Slope
Bed Of �$- 2 Force lapin ~ `i iowe0
Droin Rock from Pump Layer
'd
Cress Section Of A Mound Sy%te, Vting , E '- .--,.. ,
A Bed For The Absorption Area F . 2S
G
A Ft.
s 6=
Ft
Ft.
4, Ft.
K . r, G Ft.
L
W rF t.
L
r ,
J ¢'Observation Pipe
A
W N i4 ....�.- •_-- _w------- --- ------ � Force Main
I► f` From Pum
o
a Distribution \,.6ed Of Y_�_ 2
Pipe Drain Rock
4 Obtervotion Pipe Permanent Morkett
Pipe Or Rods
Psan View Of Mound Using A Bed for Tne Absorpti0fn Area
Perforated pipe Detail
�0
End View
�Perlo�ared
End Cop ".�� AvC P
ae Holes Located 0111110110
lJ/ Are Equally Spot **
V
PVC Force Main
F1AST 1406L watrr re Cenntc }ior
PVC
Manifold Pipe
taiSlri0ul +On
P +Re
Lost Mole Should Be
Next To Eno Cap /�
End Cap Distribution Pipe Layout P 4 O Ft.
R - .. Ft.
X, Inches
Si Y inches
6
Sig ned: Hole Diameter ^ Inch
License Number: 02 2 Ei d U Lateral " a Inch(es)
— "'—""- Mani fold 3
Inches
Gate: 3p - 9 °� Force Main " t? Inches
# of hates /PiRe°?
Invert Elevation of Laterals 3% Ft..
SEPTIC TANK S PUMP CHAMBE CROSS SECTION AND SPECIFICATIONS
4" Cl VENT PIPE I2" MIN. ABOVE GRADE 6 WEATHER PROOF
>25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK 6
FINISHED GRADE 4 CI RISER WARNING LABEL
6" MIN.
ABOVE G ADE —�.r -_ 4" MIN.
18" IN. 6" MAX.
INLET IF
I'
Pi
; P
WATER TIGHT SEALS GAS-
T
TIGHTo
„ P
BAFFLE A SEAL i ; APPROVED
-f- ALM JOINTS W/
ljPE i AP PROVE D a i ; ON APPROVED PIPE 3'
'sfli.I038OIL �'• ! Ct= SOLID SOIL
C R
PUMP OFF ELEV . FT . ---- OFF * RISER EXIT
D PERMITTED ONLY
IF 'TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE y
TANK MANUFACTURER A± 62deK : r NUMBER DOSES PER DAY
TANK SIZES SEPTIC /DS GAL. DOSE VOLUME INCLUDIN a GAL.
DOSE sa GAL
P� J
2 'F
ALARM MANUFACTURER: � �.�Zd CAPACITIES: A = INCHES = GAL.
MODEL NUMBER : ��. 33 L
SWITCH TYPE: ^ Ak / G a B = 2 INCHES =_, GAL
_ a • �NCHES = ! GAL.
PUMP MANUFACTURER: loo
MODEL NUMBER: D INCHESGAL.
SWITCH TYPE: n- oy
_ PUMP ALARM WIRING AS PER ILHR 16.23 WAC
REQUIRED DISCHARGE RATE � GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET • • --— FEET
+ MINIMUM NETWORK SUPPLY PRESSURE FEET
+ _ FEET f ORCEMAIN X j _FT/ Oa FT. F • _ . FEET
i
S ; DIAMETER
AL DIMENSIONS OF PU TANK: LENGTH � ; W ;DIN �• -
INTERN
LIQUID DEPTH
C9 2- 41 -0 -- o DATE: ��/�•
LICENSE KiMBER.:
------------
' `` C
• • i " •
1
Performance Data
,,97ol2 0 40
0 - 99
30
Pump Characteristics
A4oior Unit Sw6mordUie 1Z 40
Manna! Modals SHIF40Mi I SH 2
I Ausamu,i< MaJcls SHFF40A1 SHEP40A2 }
None Qwv 4410
' fdl toad s 12 1 8,S -
Aleter Tw ShWW Fob (4 Pale) 0
R.P.M. 1550 i 0 20 30 40 60 70
Rmse 1e GPM
Voltage its 230
T otal
60 Head Head (feet) 10 1 1 7 + 2 a 25 -_� _ Z8 ! 30 35
F uotere 12 F Ma x, Fhsid Lon. (rrs) 3.01 4.3 i 5.2 6.1
L HEmA D° n A GPM (US GPM) . 70 6Q 330 40 30 20 j 10 0
lnsdatloa 0 A (tl'tere ssec} 4. .$ 1 - 3.2 2." 1.0 .b
wh H t �_° ` c r Dimensional Data
i six °�.0_... .,....., s 4r' _...
u S& s�:r o a+a 1. A0 dimensions in inches. (Metric for
Powor Cord 18/3, Si�0 rid I tes. s� r,s»,- -� lnternotlonal use).
3,74'
2. Component dimeatslans may
Materials of Construction '�°•�' ' vary w 1/8 Inch,
tg° S I Not for canstruction p urp os e
a -�,e" yn AR�e p Pns e
tdelcatia 1111 + 199.ea} t•;:� vP' unless certified.
Mot ttous', C !r LOAT
Puma CasIn _— � ''^' " � °" 4. dimensions and weights are
sw sue_ approximate.
f mechanical Seat Fww. Cwb" /Grp
Skis sans Sect � Aeoaw Steel __�� S. We reserve the add a make
Spr stwau '- --- revisions to cur product and their
S
s p specifications without notice.
Nor 8 ,2ae.ea> _t i'2sb'' 3
tar Pkti r&dw ` --:--
6iplaeerad Tkerme'lesiir
ro' 998 Hydrompne' pumps. Aahlgnd, 0+40. Al Rights Rosoevod
14YDROMATIC Au,i,o,+ =rd GoCC1 'vi6frihuu.:r
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n:bland,No44305 lo!: 4 For 4)9281 -438;
Wob Site• www,porkiirpurnn Tons -- ----j
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-Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County �^ t
include, but not limited to: vertical and horizontal reference point (BM), direction and > Cr /
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. #
APPLICANT INFORMATION - Please print aft information Reviewed by Date
Personal inlormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 ( 1) (m)).
Property Owner Property Location
Jam, J Govt. Lot 1/4,5 1/4,S� T �! ,N,R J E (or$0
Property Owner's Mailing Address Lot # Block# Subd. Name Or CSM#
/1550 2-, - --
City State Zip Code Phone Number Road
/� .s �z ( ) ❑ Ciry ❑ Village ®Town
New Construcdon Use: esidentiai / Number of bedrooms Addition to existing building
❑ Reptacement Public or commercial - Describe:
Code derived daily flow 400 gpd Recommended design loading rate bed, gpd/ft j Z tmnch, gpdt*
Absorption area required SO 6 bed, ft trench, ft Maxlmum design loading rate Z• Z- bed, gpdt* L ' Z- trench, gpdAl
Recommended Infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design/sIte considerations
Parent material 0 / 04 . A - - Flood plain elevation, it applioable ft
S = Suitable for system Conventional Mound in -Ground Pressure AT -Grade ysWm in Fill Holding Tank
U = Unsuitable for system ❑ S U s ❑ U [Is ,s U ❑ S alt I ❑ S 031 [Is &'U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure PD
Texture structure Boundary Roots
as in. Munsell
L , 11u. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground o/ !. S . - D Y /Yi /9 �✓J.A A
12 V-ft.
Depth to
limiting
factor
, f'o2 in.
Remarks: 2/
Boring # ' „z S'� A—
.
Ground
9 ff.
Depth to
limiting
or
U in. Remarks Telephone N . ]
CST Nam (Please Print n ure ' es-
f Date CST Number
Address , i . /I > / J� . o A /i7.. J ,�/ . �1..
Address //- / o U C��1
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D.N
Boring # Horizon Depth Dominant Color Mottles 2
Texture Structure Consistence Boundary Roots
k1°k i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bpd Trench
r
,I l
Ground -1 21 .S ! J/ �7 w/� W &i!`i&
1 04 " , L tt.
Depth to
limiting
ctor
En.
Remarks:
Boring #
Ground
elev.
ft. •
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Structure
Texture Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
r# ,
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
L
Ground
elev.
ft.
Depth to
limiting
factor
` Remarks:
SBD -8330 (R.9/98)
Soil Test Plot Plan
Project Name Jaime Junker Shau d
Address 11550 Stillwater Blvd. N
Lake Elmo Mn 55042 CSTM #226900
Lot ---- Subdivision ------- Date 11/30/99
NE 1/4 SE 1/4S 27 T 3 N /R W Township Forest
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of White Stake
System Elevation 1 02.4 *HRP Same as Benchmark
Alt. BM Top of 1 1/2" Pipe @ 97.0
1320' Property Line
Scale = 1/4 = 10'
350'
12%
Alt. B.M. Slope
soo'
* BM B -2 B-1
B-3
B -3
County Road P
Pro 4
Bedroom
House
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance yAW,;'pT n ;$3:09, Wis. Adm. Code
.,:
Attach complete site plan on paper not less than 8 1/2 x 11 incheg iq #e Plar� County
ust S 't
include, but not limited to: vertical and horizontal reference poi dir4b#gR�ntY �! ��t7 f
percent slope, scale or dimensions, north arrow, and location �pa gistance'td�aFest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all ir"ation R viewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15,04 41Fft 1 7--
Property Owner J i perty Lo on = /
1/4 1/4,S,� 7 T ? 1 ,N,R E (orCW
Property Owner's Mailing Address Iock# Subd. Name or CSM#
ll s J to 5f-
City State Zip Code Phone Number ty ❑ Village ® Town Ne rest Road
❑ Ci �
4'L 1 -550 yz
New Construction Use: Wesidential / Number of bedrooms Addition to existing building
El Replacement / Public or commercial - Describe:
Code derived daily flow &0 gpd Recommended design loading rate A 2 bed, gpd/ft l 2— trench, gpd/ft
Absorption area required bed, ft dd trench, ftt�/2 Maximum design loading rate L bed, gpd/ft ` 2 - trench, gpd/ft
Recommended infiltration surface elevation(s) /U �• 7 ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material L442'.,� • Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S U ❑ U ❑ S ,,E- U ❑ S 1�3 ❑ S EE�_u ❑ S Q(U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
- g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
Ground 3 �o l� O y� l �i/9 �l Q i P
9 eev ;
�ft.
Depth to
limiting
factor
Remarks:
Boring #
FS-3 0
3 7
Ground
Depth to
limiting
factor
in. Remarks:
CST Nam (Please Print i nature Telephone N .
Address Date CST Number
1
SOIL DESCRIPTION REPORT ,
PROPERTY OWNER Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
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Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
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SBD -8330 (R.9/98)
Soil Test Plot Plan
Project Name Jaime Junker Shaun / J�
Address 11550 Stillwater Blvd. N
Lake Elmo Mn 55042 CSTM #226900
Lot ---- Subdivision --- -- -- Date 11/30/99
NE 1/4 SE 1/4S 27 T 31 N /13 W Township Forest
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of White Stake
System Elevation 1 02.4 *HRP Same as Benchmark
Alt. BM Top of 1 1/2" Pipe @ 97.0
1320' Property Line
Scale = 1/4 = 10'
350'
12%
Alt. B.M. Slope
* B.M. B -2 B -1
800'
B -3
County Road P
Pro 4
Bedroom
House
i
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
i
Owner/Buyer �Gl rn M n a-i N k-9- r
Mailing Address 11 S 5 O s . (1 L.A.- _ • L. K� L (M t7 N Ss0y�
Property Address �.► `(
(Verification required from Planning Department for new construction)
City/State ro rr e 4 J VJT Parcel Identification Number O i`t _. yy 014 - los 7 - 60
01' -107 01(-1 - 1057 -'70
LEGAL DESCRIPTION
Property Location LI�Y % , , � %,, Sec T N -R/�-fW, Town of F 0 f f Q S � .
Subdivision A Lot #
Certified Survey Map # - , Volume . Page #
Warranty Deed # cam/ ��/ , Volume / Page #
Spec house ❑ yes no Lot lines identifiable) yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SIG 16 OF APPLIC DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property descri above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIG OF APPLI A DATE
* * * * ** Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department.****
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
1 614901
75 EED FAG: 5, tU REGISTER OF D
S
Document Number WARRANTY DEED y ST. CROIX CO., WI
RECEIVED FOR RECORD
Ned A. Hahn and Becky S. Hahn, husband and wife, conveys and 12-03 -1999 9:30 AN
warrants to Jaime P. Junker and Maureen O Junke husband and wife,
the following described real estate in St. Croix County, State of Wisconsin: YARRWITY DEED
CUT COPY FEE:
COPY FEE:
TRANSFER FEE: 351.00
RECORDING FEE: 10.00
PAGES: 1
Recordina Area
Name and Return Address
Thomas A. McCormack
1020 10d"Avenue
Baldwin, WI 54002
014 - 1057.40;- 50,- 60, -70
(Parcel IdenlifloaWn Number)
The Southeast Quarter (SE ' /.) of Section Twenty -seven (27), Township Thirty -one (31) North, Range
Fifteen (15) West, except Highway Right -of -Way and except part of the Southeast Quarter of the
Southeast Quarter (SE % of BE %) of said Section Twenty -seven (27), Township Thirty -one (31) North,
Range Fifteen (15) West, Town of Forrest, St. Croix County, Wisconsin, more particularly described as
Lot 1 of Certified Survey Maps filed November 4, 1999, in Volume 13 of Certified Survey Maps, Page
3763, as Document No. 613323, Office of the Register of Deeds for St. Croix County, Wisconsin.
Subject to terms and conditions of Farmland Preservation Agreement with the State of Wisconsin dated
January 7, 1986, and recorded January 21, 1986, in Volume 730 of Records, page 550, as Document
No. 408670.
Exception to warranties: all easements and restrictions of record.
This is not homestead property. Dated this day of /houC�+ 1999.
��YGr" c t - '7�I�✓
' 'Ned shin
'Becky S. Hahn
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN
ST. CROIX COUNTY 1tt
Personally came before me this � 9: da or
1999 the above named Ned A. Hahn and Becky S. Hahn,
authenticated this _day of husband wife, to me known to be the person(s) who
exsout tare foregoing ins ument and acknowledge the
•. a
signature
y1X11�k�
type or print name Sig
tyrl or print name `A/ ' r
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not Notary Public St. Croix County, Wisconsin.
authorized by §706.06, WIS. Stabs.) My commission is permanent. (If not, state expiration date:
1 -31- 3213
THIS INSTRUMENT WAS DRAFTED BY
Thomas A. McCormack *Names of persons signing in any capacity should be typed or
Baldwin, WI 54002 printed below their signatures.
KATI ILEN iUTHL�y Pi a
W O N
Infnrm�4inn Dmfoeeinnolo ('mm�em Fnnrf !'ire